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Dare County is ready for the expanded Medicaid program, but is waiting on the adoption of a state budget.

Sheila Davies, the county’s director of Health and Human Services, told the Board of Commissioners on July 17, 2023 that no implementation date has been set.

Davies said the expansion program “gets people connected to preventive services and early intervention. Expanding Medicaid will connect more people to mental health and substance abuse treatment as well as chronic disease management.”

Medicaid expansion is part of the Affordable Care Act. Some 38 states have implemented the program. A dozen states, including North Carolina, have not. One state has adopted but not implemented the program.

This year the General Assembly acted. On Feb. 16, 2023, the North Carolina House adopted the expansion legislation, followed by the state Senate on March 15. Gov. Roy Cooper signed the legislation March 27.

The state legislation specifically ties implementation to passage of the state budget. Davies reported that implementation depends on increased staff and resources across the state.

The program expansion is 90% federally funded, reported Chuck Lycett, director of Social Services.

In North Carolina, local Social Services divisions are responsible for determining eligibility.

Dare County has received $38,880 for five months of start-up costs. After Oct. 1, the monthly amount for Dare’s administration costs will be $7,776. Salary expenses are apportioned 75% for federal funds and 25% for county share.

Lycett showed what Medicaid expansion, now called NC Health Works, will accomplish in the state. In February 2020, Dare County had 5,482 people using the Medicaid program. In March, 2023, the number of people using the program stood at 7,083.

Health Works estimates that another 1,843 people in Dare will be eligible.

To start the program in Dare County, the Social Services Division needs three income maintenance caseworkers – rising eventually to five caseworkers – one quality control caseworker and one supervisor.

Lycett told the commissioners that the estimated county share for the initial year is $31,000, which can be covered from the Social Services Division’s fiscal year 2024 budget.

County manager Robert L. Outten told the commissioners “Dare would need to cover the second year if more funding is needed.” The county’s share of salaries under a fully implemented program would be $64,000.

In June, when adopting the fiscal year 2024 budget, the commissioners authorized the three new caseworkers. On July 17, 2023, the commissioners authorized positions for the quality control caseworker and supervisor.

In a health division matter, Outten said he wanted to combine two part-time positions to create a job for a full-time midwife or advanced level practitioner. He said the division is finding it difficult to find a part-time health care physician and advanced level practitioner. The board approved the new fulltime position. The switch is revenue neutral.

On the commissioners’ consent agenda, the commissioners:

– Adopted a budget amendment Department of Health and Human Services to continue implementing its approved community-based strategies to prevent fatal and non-fatal opioid overdoses. “Funding will be used to maintain and support the syringe services program, increase the connection of justice involved persons to care and to maintain and expand the post overdose response.” Additionally, increased funding is available to purchase and distribute more supplies for overdose prevention and harm reduction response. The grant program budget is $37,000.

– Adopted a budget amendment for continued funding from The Outer Banks Hospital Grants Program for “a public awareness and education campaign for the Breaking Through Task Force to reduce the stigma related to behavioral health and to improve the overall wellness of our community through better access to care, support, improved functioning and promotion of positive mental health. Funding will be used for public awareness campaigns, promotional materials, educational materials, and various other needs which will assist and enhance access to care,” from the July 17, 2023 board agenda book. The grant amount is budgeted at $7,500.

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